KAISER DAILY HIV/AIDS REPORT
A service of kaisernetwork.org
http://www.kaisernetwork.org/dailyreports/hiv

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
*** WEBCAST: AMFAR HIV/AIDS UPDATE CONFERENCE***
View a webcast of amfAR’s 15th National HIV/AIDS
Update Conference, covering issues such as
prevention, treatment, care and services, mental
health and substance use, and the global epidemic.
http://www.kaisernetwork.org/healthcast/amfar/apr03
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
________________________________________



Friday, April 4, 2003

ACROSS THE NATION
========================================
1. ACLU Demands Florida Health Department Remove Religious HIV/AIDS Booklet

2. Contract Dispute Between Norfolk, Va., City Officials and Local Doctors
Puts HIV Treatment Network in 'Immediate Jeopardy'


DRUG ACCESS
========================================
3. Gilead To Sell Its Antiretroviral Drug Viread to 68 Developing Countries
'At Cost'


GLOBAL CHALLENGES
========================================
4. Decline in Working Population Due to HIV/AIDS Presents Challenge to
South African Economy, Report Says

5. Burma's Military Government 'Practically Ignored' Country's AIDS
Epidemic Until Last Year, Observers Say


OPINION
========================================
6. Shift in HIV Incidence to Minority Populations Requires Shift in
Prevention Efforts, Boston Globe Columnist Says

****************************************

ACROSS THE NATION

1. ACLU Demands Florida Health Department Remove Religious HIV/AIDS Booklet

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=16992

The American Civil Liberties Union of Florida yesterday demanded that the
Florida Department of Health remove from its inventory an HIV/AIDS booklet
called "A Christian Response to AIDS," which includes quotes from the Bible
and a picture of Jesus Christ, the Fort Lauderdale Sun-Sentinel reports.
Howard Simon, executive director of the Florida ACLU, said that the purpose
of the brochure was to promote a particular religious viewpoint rather than
to educate people about HIV/AIDS (LaMendola, Fort Lauderdale Sun-Sentinel,
4/4). "It's clearly unconstitutional," Simon said, adding, "It is not
permissible for the state to spend a dime endorsing a particular
theological point of view" (Lauer, Tallahassee Democrat, 4/4). The ACLU
yesterday sent a letter to Dr. John Agwunobi, secretary of the state health
department, and Beth Swisher of the Florida Bureau of AIDS expressing its
concerns and requesting that the brochure be pulled (Canedy, New York
Times, 4/4). Simon said that about 13,500 copies of the 16-page brochure
were bought by the health department in 2001 and 2002, according to the
Miami Herald. Health department officials said that the brochure is on a
list of state-approved HIV/AIDS education materials. Tom Liberti, director
of the Florida Bureau of AIDS, said that the department purchased the
pamphlets after they were requested by faith-based organizations --
particularly black groups -- that were involved in prevention programs,
according to the Herald (Robinson, Miami Herald, 4/4). Liberti said that
he would be spending a week speaking to groups and other states that use
the brochure before deciding what action to take, according to the
Sun-Sentinel. "One of two things will happen. We'll either remove [the
brochure] or have a pretty strong justification for keeping it on the
list," Liberti said (Fort Lauderdale Sun-Sentinel, 4/4).

More Criticism


The brochure, which was first published in 1990, has been distributed in
other states, where it has also been criticized, according to the
Associated Press (Royse, Associated Press, 4/3). The Pennsylvania
Department of Health last month removed from its Web site the same
religious-themed AIDS pamphlet, which was included in a list of educational
brochures. The agency commenced a review of the appropriateness of the
pamphlet after Capitolwire, an online state government news service
questioned its presence on a state Web site. The department initially
purchased 10,000 brochures in 2002 and distributed them to churches as part
of an effort to educate the black community about HIV/AIDS. Two years ago,
Washington, D.C., health officials were criticized for offering the
brochure. District health officials said that an error had been made in
ordering the pamphlet, and they stopped distributing it (Kaiser Daily
HIV/AIDS Report, 3/17).

2. Contract Dispute Between Norfolk, Va., City Officials and Local Doctors
Puts HIV Treatment Network in 'Immediate Jeopardy'

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=16993

A contract dispute between city officials in Norfolk, Va., and doctors
from the Eastern Virginia Medical School's AIDS clinic network regarding
billing practices has resulted in the revocation of federal Ryan White CARE
Act funds, a move that public health officials say has put the region's HIV
treatment network in "immediate jeopardy," the Virginian-Pilot reports.
Shirley Tyree, a city employee in charge of the disbursement of Ryan White
funds, said that EVMS clinics use a billing method in which doctors receive
a set fee for each patient, a practice that is not allowed under federal
government regulations. As a result, the clinics, which are the primary
source of HIV/AIDS care for 1,200 of the area's uninsured and underinsured
patients, have lost their Ryan White funds and on Monday notified patients
that care may no longer be available. Dr. Edward Oldfield, director of
infectious disease at EVMS and founder of the system of satellite clinics,
said that the billing practice has been in place for three years and does
not violate federal regulations. Iris Jessie, an assistant city manager in
Norfolk, said that the funds had been cut because federal officials thought
the region's overall medical care costs were too high. Oldfield said that
not only are the clinics' costs average, but the region over the past two
years has failed to spend more than $1 million in federal funds.

Other Sources of Care


Norfolk officials offered to allow EVMS to retain its clinic in South
Hampton Roads, closing the three other locations in Williamsburg, Hampton
and Newport News. Patients from those areas would have to be treated at
the more "cost effective" Peninsula Institute for Community Health, city
officials said. Oldfield has refused to offer services only in South
Hampton Roads, saying that it is unethical to provide a standard of care
for some patients while depriving others of that same standard of care. He
added that the Peninsula Institute is not equipped to deal with the AIDS
patients because it has no infectious disease specialists on staff.
Without the assistance of the EVMS clinics, AIDS patients will have to seek
care from the Chesapeake Health Department, Tyree said, but Dr. Nancy
Welch, director of the health department, said that the center has "never
been set up to handle this," adding, "We can't provide AIDS care if it's
not in conjunction with EVMS ... [which has] the hospital care and
infectious disease expertise" (Szabo/Kruse, Virginian-Pilot, 4/3). The
Greater Hampton Roads HIV Health Services Planning Council met last night
to discuss the changes. About 24 clinic patients attended the meeting to
voice their concerns about possible disruptions in access to and quality of
AIDS care. Norfolk officials said that that they are still trying to
negotiate with EVMS and are waiting for a response to a letter sent
Wednesday (Kruse, Virginian-Pilot, 4/4).


DRUG ACCESS

3. Gilead To Sell Its Antiretroviral Drug Viread to 68 Developing Countries
'At Cost'

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=16994

Foster City, Calif.-based Gilead Sciences is scheduled to announce today
that it will sell its antiretroviral drug Viread "at cost" -- approximately
one tenth of its retail price -- to 68 developing countries, the Los
Angeles Times reports (White, Los Angeles Times, 4/4). The company
announced in December 2002 that it would offer Viread, known generically as
tenofovir, at cost to all African nations and 15 other low-income
countries. The access program will allow qualified programs to purchase
the drug at the lower price. Treatment programs will be able to apply
online, or by mail, fax or e-mail, to purchase Viread at the reduced cost.
The company will choose eligible applicants based on their "ability to
sustain an effective treatment program, adequately prescribe and monitor
patients and store and use the drug appropriately" (Kaiser Daily HIV/AIDS
Report, 12/18/02). The company said that it will offer Viread for $1.30 a
day, or $475 per person per year, which it said covers only the cost of
manufacturing the drug and oversight of the distribution program. The drug
costs approximately $4,300 per person per year in the United States, the
Wall Street Journal reports (Wall Street Journal, 4/4).

Securing Additional Funding


Gilead also said it will change the color of pills manufactured for the
program to try to prevent the drug from being "diverted to more affluent
nations" through drug resale, the Times reports (Los Angeles Times, 4/4).
Gilead CEO John Martin said, "The Gilead Access Program was created in
consultation with experts and advocates, with the objective of making
Viread available where the need is greatest and in a way that best
addresses the treatment landscape in the developing world" (Gilead release,
4/4). He added, "Based on its efficacy, positive resistance and
side-effect profile, and once-daily dosing, we believe that Viread will be
a particularly important treatment option for physicians and patients in
these regions" (Tansey, San Francisco Chronicle, 4/4). Gilead CFO John
Milligan said that the price is still "very prohibitive for less developed
nations, so we've been working with groups to help secure funding for these
countries. We're trying to do our part" (Jacobs, San Jose Mercury News,
4/4). He added that the Bush administration has said that they will
support funding such efforts, the San Francisco Chronicle reports. The
William J. Clinton Foundation and the World Health Organization are
currently trying to establish funding for the program, according to
Milligan (San Francisco Chronicle, 4/4).

Reaction


AIDS advocates lauded the announcement, the Times reports. Charles
Farthing, chief of medicine for the AIDS Healthcare Foundation, said,
"[Viread] is a phenomenally good drug that will make treatment in the Third
World easier because it is potent and relatively free of side effects" (Los
Angeles Times, 4/4). Mark Harrington, executive director of the Treatment
Action Group, said, "They are a small biotech company, and they came out
faster with an offer than the large drug companies did when they got drugs
approved, so they have to be praised" (San Jose Mercury News, 4/4).


GLOBAL CHALLENGES

4. Decline in Working Population Due to HIV/AIDS Presents Challenge to
South African Economy, Report Says

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=16995

The possibility of a declining workforce due to HIV/AIDS presents the
"greatest challenge" to South Africa's labor market this year, according to
a report by Andrew Levy Employment Publications, Reuters reports. South
Africa has an estimated 4.7 million HIV-positive people, the highest number
of any country in the world. Over the next four years, the number of
HIV-positive South Africans could increase to approximately eight million,
with an additional 700,000 "potentially economically active" people between
the ages of 20 and 59 becoming infected by 2010, according to the Levy
report, Reuters reports. "As a result of the AIDS epidemic, the shrinking
of the working age population will translate directly into the shrinkage of
available labor resources and a risk of declining productivity," the report
states, according to Reuters (Reuters, 4/2). Labor-intensive industries,
such as mining, have been particularly hard hit by HIV/AIDS, and service
industries such as banking and food products may have to project slower
growth in coming years due to a declining consumer base. A number of
banks, including Deutsche Bank and Dresdner Bank, have said that HIV/AIDS
statistics will have to be included in financial forecasting, stock
selection, asset allocation and risk underwriting (Kaiser Daily HIV/AIDS
Report, 3/25). According to the Levy report, Gauteng, the South African
province that accounts for 35% of the country's gross domestic product,
could lose 500,000 adults by 2010, Reuters reports. Due to high HIV
prevalence rates in South Africa, businesses may decide to locate
elsewhere, which could lead to a decline in direct foreign investment,
according to Reuters. Spending patterns could also shift from retail items
to medication, care for AIDS orphans and funeral costs. In addition,
HIV/AIDS compounds other economic problems facing South Africa, such as
high unemployment, poverty, low foreign investment and low savings,
according to the report (Reuters, 4/2).

5. Burma's Military Government 'Practically Ignored' Country's AIDS
Epidemic Until Last Year, Observers Say

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=16996

Many observers say that the military government of Burma, an
"impoverished" nation that has only two hospitals with AIDS wards, until
last year "practically ignored" the country's AIDS epidemic, causing a
"dire situation," the San Francisco Chronicle reports. UNAIDS estimates
that the country, which has a population of 48 million, had 400,000
HIV-positive people by the end of 2001, or just under 1% of the 15- to
49-year-old adult population. However, the junta has said that the number
of HIV-positive people in the country is much lower, citing a culture that
stresses abstinence before marriage and fidelity after marriage. State-run
AIDS prevention campaigns have stressed monogomy over the use of condoms
and clean needles. Chris Beyrer, an epidemiologist at the Johns Hopkins
University Bloomberg School of Public Health who has worked with the World
Health Organization in Burma, said, "There has been a complete failure [in
the case of AIDS] on so many levels. ... The health care system is in
collapse, grossly underfunded and neglected by the junta," adding, "The
junta has been a disaster." However, Tony Lisle, UNAIDS' director for
Southeast Asia, said that in the past 18 months there has been an "absolute
groundswell of change in Myanmar," adding that the military government has
finally recognized AIDS as a "serious issue." Lisle said that the
government has begun a needle-exchange program, an AIDS awareness
advertising campaign and a soap opera that addresses AIDS and condom use,
and it has appointed a prominent doctor as the new minister of health. One
Western health care worker said, "It's all moving in the right direction"
(Frankel, San Francisco Chronicle, 4/3).


OPINION

6. Shift in HIV Incidence to Minority Populations Requires Shift in
Prevention Efforts, Boston Globe Columnist Says

Access this story and related links online:
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=16997

The shift in populations at high risk of contracting HIV -- from injection
drug users and gay men to blacks and Latinos -- necessitates a renewed
effort to disseminate "the message that safe sex can be a matter of life or
death," Adrian Walker writes in his Boston Globe column. The ability of
antiretroviral drugs to prolong the lives of HIV-positive people and the
commitment of both President Bush and former President Clinton to fighting
the disease is encouraging, he states. However, HIV/AIDS is "far from
having gone away," and the virus is spreading among people "who do not
consider themselves part of high-risk groups," Walker says. He notes the
concern of some AIDS advocates that the recent focus on global AIDS could
lessen the domestic commitment to fighting the disease, adding that
advocates say that "we should make sure local needs continue to be
addressed" while global funding is increased. Walker concludes with a
quote from Darrell LeMar, director of prevention and community education at
the AIDS Action Committee, who says that there is still a need to
"destigmatize this [disease] and start talking about how anybody who isn't
practicing safe sex is still at risk of HIV infection" (Walker, Boston
Globe, 4/3).


________________________________________

-------------------------------------------------------
CONTACT DAILY REPORTS EDITORIAL STAFF
http://www.kaisernetwork.org/contact/contact.cfm
EDITORIAL PHONE: 202-672-5952 FAX: 202-672-5767
EDITORIAL E-MAIL: dailyreports@...
E-MAIL REGISTRATION: www.kaisernetwork.org/email

The Kaiser Daily HIV/AIDS Report is published for kaisernetwork.org, a
service of The Henry J. Kaiser Family Foundation, by The Advisory Board
Company. © 2003 by The Advisory Board and Kaiser Family Foundation. All
rights reserved.
-------------------------------------------------------
kaisernetwork.org Editorial Contacts:
For editorial questions about kaisernetwork or the Kaiser Daily HIV/AIDS
Report, please contact Larry Levitt, Kaiser Family Foundation vice
president, editor-in-chief, kaisernetwork.org; Joshua Perin,
editor-in-chief, Daily Reports; Alyson Browett, editor, Kaiser Daily
HIV/AIDS Report; or Susannah Hunter, associate editor, at
dailyreports@....
-------------------------------------------------------
kaisernetwork.org Contacts:
Marla Bolotsky, Vice President; Director, Online Information
Robin Sidel, Senior Outreach Associate
Dana Greil, Online Coordinator
For questions and further information about kaisernetwork.org, please
contact us at info@... or at 202-347-5270.
--------------------------------------------------------
Manage Your Email Subscription at http://www.kaisernetwork.org/email .
SUBSCRIBE by choosing "Create a new subscription."
CHANGE your subscription by logging in and choosing "Update your Report
Preferences."
UNSUBSCRIBE by logging in and choosing "Please delete my profile."
-------------------------------------------------------
kaisernetwork.org is a free service of the Kaiser Family Foundation. For
access to the Foundation's policy research, analyses, reports and fact
sheets, and media partnerships, visit the Foundation's main website at
www.kff.org.